The C-MAC® video laryngoscope is superior to the direct laryngoscope for the rescue of failed first-attempt intubations in the emergency department.

OBJECTIVE: To compare the effectiveness of the C-MAC® video laryngoscope (CMAC) to the direct laryngoscope (DL) when used to rescue a failed first attempt intubation in the emergency department (ED). METHODS: Data were prospectively collected on all patients intubated in an academic ED center over a five-year period from February 1, 2009 to January 31, 2014 when both the CMAC and the DL were available. Following each intubation the operator completed a continuous quality improvement (CQI) form documenting patient, operator and intubation characteristics. All orotracheal intubations attempted by emergency physicians (EPs) on adult patients with a failed first intubation attempt, and in which the CMAC or the DL was used for the second attempt, were included. The primary outcome was successful intubation on the second attempt using either the CMAC or the DL. A multivariate logistic regression analysis was performed to adjust for potential confounders. RESULTS: During the five-year study period, there were 460 adult orotracheal intubation attempts by EPs which were not successful on the first attempt. In 398 (86.5%) of these cases the same operator performed the second attempt. The CMAC was utilized for the second attempt in 141 cases and was successful in 116 (82.3%; 95% CI 75.0%-88.2%) and the DL was utilized in 94 cases and was successful in 58 (61.7%; 95% CI 51.1%-71.5%). In a multivariate logistic regression analysis the CMAC was associated with an increased odds (adjusted OR 3.5; 95% CI 1.9-6.7) of a second attempt success compared to the DL. CONCLUSIONS: After a failed first intubation attempt in the ED, regardless of the initial device used, the CMAC was more successful than the DL when used for the second attempt. This suggests that the CMAC is the preferred rescue device after an initial intubation attempt in the ED fails.

A comparison of the C-MAC video laryngoscope to the Macintosh direct laryngoscope for intubation in the emergency department.

STUDY OBJECTIVE: We determine the proportion of successful intubations with the C-MAC video laryngoscope (C-MAC) compared with the direct laryngoscope in emergency department (ED) intubations. METHODS: This was a retrospective analysis of prospectively collected data entered into a continuous quality improvement database during a 28-month period in an academic ED. After each intubation, the operator completed a standardized data form evaluating multiple aspects of the intubation, including patient demographics, indication for intubation, device(s) used, reason for device selection, difficult airway characteristics, number of attempts, and outcome of each attempt. Intubation was considered ultimately successful if the endotracheal tube was correctly inserted into the trachea with the initial device. An attempt was defined as insertion of the device into the mouth regardless of whether there was an attempt to pass the tube. The primary outcome measure was ultimate success. Secondary outcome measures were first-attempt success, Cormack-Lehane view, and esophageal intubation. Multivariate logistic regression analyses, with the inclusion of a propensity score, were performed for the outcome variables ultimate success and first-attempt success. RESULTS: During the 28-month study period, 750 intubations were performed with either the C-MAC with a size 3 or 4 blade or a direct laryngoscope with a Macintosh size 3 or 4 blade. Of these, 255 were performed with the C-MAC as the initial device and 495 with a Macintosh direct laryngoscope as the initial device. The C-MAC resulted in successful intubation in 248 of 255 cases (97.3%; 95% confidence interval [CI] 94.4% to 98.9%). A direct laryngoscope resulted in successful intubation in 418 of 495 cases (84.4%; 95% CI 81.0% to 87.5%). In the multivariate regression model, with a propensity score included, the C-MAC was positively predictive of ultimate success (odds ratio 12.7; 95% CI 4.1 to 38.8) and first-attempt success (odds ratio 2.2; 95% CI 1.2 to 3.8). When the C-MAC was used as a video laryngoscope, a Cormack-Lehane grade I or II view (video) was obtained in 117 of 125 cases (93.6%; 95% CI 87.8% to 97.2%), whereas when a direct laryngoscope was used, a grade I or II view was obtained in 410 of 495 cases (82.8%; 95% CI 79.2% to 86.1%). The C-MAC was associated with immediately recognized esophageal intubation in 4 of 255 cases (1.6%; 95% CI 0.4% to 4.0%), whereas a direct laryngoscope was associated with immediately recognized esophageal intubation in 24 of 495 cases (4.8%; 95% CI 3.1% to 7.1%). CONCLUSION: When used for emergency intubations in the ED, the C-MAC was associated with a greater proportion of successful intubations and a greater proportion of Cormack-Lehane grade I or II views compared with a direct laryngoscope.

Physical Activity and Healthy Aging.

Healthy aging is the ability to maintain independence, purpose, vitality, and quality of life into old age despite unexpected medical conditions, accidents, and unhelpful social determinants of health. Exercise, or physical activity, is an important component of healthy aging, preventing or mitigating falls, pain, sarcopenia, osteoporosis, and cognitive impairment. A well-balanced exercise program includes daily aerobic, strength, balance, and flexibility components. Most older adults do not meet the currently recommended minutes of regular physical activity weekly. Counseling by health care providers may help older adults improve exercise habits, but it is also important to take advantage of community-based exercise opportunities.

The effect of stylet choice on the success rate of intubation using the GlideScope video laryngoscope in the emergency department.

OBJECTIVES: The objective was to determine whether the using the GlideRite rigid stylet (GRS) compared with a standard malleable stylet (SMS) affects the success rate of intubation using the GlideScope in emergency intubations. METHODS: This was a retrospective analysis of prospectively collected continuous quality improvement (CQI) data based on intubations performed in an academic emergency department (ED) over a 4-year period. Following each intubation the operator completed a data form regarding multiple aspects of the intubation, including the device used, type of stylet used, procedural complications, outcome of the intubation, difficult airway predictors (DAPs), and the operator's postgraduate year (PGY). Intubation was considered successful if the GlideScope was used as the initial device and resulted in successful intubation of the trachea. RESULTS: Over the 4-year study period, the GlideScope video laryngoscope (GVL) was used for 473 intubations. Of these, 322 (68%) used the GRS, while 151 (32%) used the SMS. When the GRS was used, operators were ultimately successful in 93.5% of cases (301 of 322), whereas when the SMS was used, operators were successful in 78.1% of cases (118 of 151; p < 0.0001). The first-attempt success rate for the GRS group was 82.9% (267 of 322) and for the SMS group was 67.5% (102 of 151; p < 0.001). The mean (± standard deviation [SD]) complication rate was 0.25 (±0.5) in the GRS group and was 0.47 (±0.7) in the SMS group (p = 0.0003). In the GRS group, 18% of patients (58 of 322) had oxygen desaturation, while in the SMS group, 31% of patients (46 of 151) had oxygen desaturation (p = 0.003). The mean number of DAPs was 2.0 (±1.5) in the GRS group and 2.0 (±1.5) in the SMS group (p = 0.65). The mean (±SD) PGY of the operator was 2.2 (±0.8) years in the GRS group and 2.2 (±0.8) years in the SMS group (p = 0.79). CONCLUSIONS: Both first-attempt and ultimate success rates were higher with GlideScope intubations in the ED when the rigid stylet was used compared to the malleable stylet. The number of complications and, in particular, the incidence of oxygen desaturation were lower in the GRS group than in the SMS group. The two stylet groups were similar regarding difficulty of the airway and experience level of the operator.